Analysis of resource use and cost-generating factors in a German medical intensive care unit employing the Therapeutic Intervention Scoring System (TISS-28)

Intensive Care Medicine
Jürgen GrafUwe Janssens

Abstract

Evaluation of resource use and costs of a medical intensive care unit (ICU) utilising the simplified Therapeutic Intervention Scoring System (TISS-28). Prospective observational study. : Medical ICU of a tertiary care centre. Consecutive patients with an ICU length of stay (LOS) more than 24 h. Over a 3 month period SAPS II, TISS-28 and SOFA were determined daily. Patients were retrospectively classified as receiving active (AT) or non-active (NAT) treatment according to TISS-28 variables, with AT representing a therapeutic intervention that could not be performed outside the ICU. Individual expenditure for all patients was calculated using a modified 'top-down' method. Out of 303 consecutive patients, 241 (79.5%), including all non-survivors, were categorised AT. The hospital mortality was 14.5%. TISS-28 and ICU LOS were higher in patients receiving AT ( p<0.001). Patient-specific costs accounted for 36 EUR per TISS-point and daily treatment costs 1336 EUR for all patients. Daily costs of care were 68 EUR higher for AT, compared to NAT, patients ( p<0.001). There was no association between ICU costs and measures of severity of illness (SAPS II, SOFA). TISS-28 is a fast, reliable and readily applicable tool to identify patients...Continue Reading

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